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Therapeutic Uses of Psilocybin

Lately, professionals in psychiatry have been demonstrating increasing interest in the potential benefits of hallucinogenic substances such as LSD, MDMA, ketamine, and DMT. Recent psychedelic research has indicated that psychedelic therapy could treat previously intractable conditions, improve patients’ well-being, lead to decreases in their side effects, and even facilitate mystical experiences.

In recent years, patients with certain qualifying mental and behavioral disorders seeking non-traditional therapies to treat intractable conditions such as addiction, anxiety, or depression have found some relief from chronic symptoms in their states’ medical marijuana programs. While many patients have benefited from medical marijuana’s broadening accessibility, others have struggled to satisfactorily treat their symptoms.

Therapeutic Uses of Psilocybin

Many psychiatric patients currently dissatisfied with the ineffective treatment of their chronic mental health disorders by psychopharmacology are exploring the therapeutic potential of psilocybin—the psychoactive compound found in psychedelic or “magic mushrooms.”

Since they haven’t received symptom relief from traditional treatments like antidepressants or opioids, they’ve decided to partake in clinical studies that allow them to experiment with psychedelic compounds. Some have also attempted to find therapists willing to conduct psilocybin-assisted therapy sessions to better treat certain mental health disorders.

Several recent psilocybin research studies (many of which were double-blind, randomized, and/or placebo-controlled) run by healthcare professionals in which subjects used psilocybin mushrooms have cited promising results regarding the treatment of certain mental conditions like drug and alcohol use disorder, anxiety, depression, post-traumatic stress disorder (PTSD), and a variety of other substance use disorders and psychiatric disorders.

It’s early, and researchers and clinicians will need to conduct follow-up studies to confirm the efficacy and safety of psilocybin treatment for cancer patients and those with other serious medical conditions, but the evidence that has emerged so far is encouraging. In fact, the U.S. Food and Drug Administration (FDA) has granted a breakthrough therapy designation for psilocybin, which will enable researchers at Johns Hopkins University and elsewhere to conduct further psychedelic studies.

Psilocybin for Anxiety

Many scientific studies have shown that psilocybin can be extremely helpful in treating certain mental health conditions, such as anxiety disorders, especially when administered during a carefully monitored psychotherapy session and combined with other traditional talk therapies.

Among these studies, however, only a small handful include data directly comparing the use of psilocybin vs. other psychedelic drugs for the specific treatment of anxiety and other related mood disorders. That said, despite the limited data, psilocybin has stood out from its psychedelic peer group as having the most promise for treating conditions such as anxiety disorders.

The most recent research placing psilocybin centerstage as the go-to alternative therapy for treating anxiety disorders has also indicated strongly that the drug could, in fact, have substantial and even long-lasting reparative benefits.

Researchers have found that psilocybin can act on the brain's chemistry in two ways. First, it can increase the connectivity between areas of the brain that aren't communicating as well as they should be, and second, it can stifle communication among local brain networks that normally interact very frequently.

At a time in history when existing treatments for anxiety disorders are failing patients and research into the efficacy of traditional treatments has stalled, psilocybin-assisted therapy offers many unique opportunities for the continued study and treatment of anxiety disorders.

Psilocybin for PTSD

Since psilocybin-assisted therapy has shown such great promise in helping to treat other mental disorders, it seemed warranted by many in the psychiatric community to investigate its application to treat post-traumatic stress disorder (PTSD).

Although still in its early stages, research so far has shown that psilocybin-assisted therapy could have a transformative effect on the quality of life for those suffering from PTSD, which is a complex disorder that expresses a variety of symptoms. The main symptoms include anxiety, depression, and increased risk for substance abuse. Other PTSD symptoms include flashbacks and nightmares, which can be debilitating.

At present, only two medications—paroxetine (Paxil) and sertraline (Zoloft)—have U.S. Federal Drug Administration (FDA) approval for treating PTSD. Also, no formal clinical trials have yet examined the treatment of PTSD using psychedelics, including psilocybin.

But since the use of psilocybin-assisted therapy has been studied for the treatment of other mental disorders, such as anxiety and depression, several small, isolated studies have already shown encouraging results.

While the exact mechanisms by which psilocybin exerts its therapeutic effects are not fully understood, it is thought to work in part by helping to reduce activity in the default mode network (DMN), a brain network associated with self-reflection and rumination. For those with PTSD, psilocybin may help to break the cycle of negative thinking and rumination that can perpetuate the condition.

If you are interested in exploring psilocybin-assisted therapy for PTSD, it is important to work with a qualified therapist or provider who is experienced in this type of treatment. Psilocybin should not be used without the supervision of a trained professional. If you are considering psilocybin therapy for PTSD or any other condition, be sure to speak with your mental health professional to see if it is right for you.

Psilocybin for Migraines

Many who hear the word “migraines” immediately think of debilitating headaches, which is partially correct, as painful and sometimes long-lasting headaches are a symptom of what is actually a neurological disease. Symptoms also include dizziness, nausea, vomiting, and sensitivity to lights, sounds, and sometimes smells.

Commonly, the pain experienced from migraines is so severe that migraine sufferers also lose the ability to perform normal everyday activities like working, attending social events, and exercising.

Although not a great deal of research has been done on the effects of psilocybin on migraines, some researchers speculate that the psychedelic drug could aid in the reduction of inflammation and pain. This is because psilocybin, much like other psychedelics, binds to certain serotonin receptors in the brain, altering the body’s networked response system and improving its ability to suppress severe and chronic pain.

Limited studies have also reported migraine sufferers experiencing temporary relief from certain migraine symptoms due to the calming effects of psilocybin. Specifically, some studies have demonstrated the reduction of stress and related anxiety associated with migraine episodes through controlled micro-dosing of psilocybin.

Psilocybin for OCD

Obsessive-compulsive disorder (OCD) is a little-understood mental health condition that combines obsessive thoughts with compulsive behavioral actions. Despite the condition’s long history of research and study, specialists can’t reach a definitive consensus on OCD’s causes let alone agreed upon cause, let alone its treatment.

Whether one considers it to be an anxiety-based condition signaling a need for survival, or a distress-based condition shaped by an extreme uneasiness and an inability to return to a state of calm, OCD seems to evade not only a comprehensive definitive, but an agreed-upon treatment.

The four most common OCD-related obsessions are:

  • Cleanliness and contamination
  • Catastrophizing (worrying something terrible will happen to oneself or a loved one)
  • Order and “just right” thinking (the idea that “all must be in place,” otherwise there cannot be calm)
  • Taboo thoughts (usually about a morally reprehensible, socially unacceptable, or blasphemous action)

At present, FDA-approved OCD treatments include selective serotonin reuptake inhibitors (SSRI medication) and cognitive behavioral therapy (CBT), in addition to the FDA-cleared transcranial magnetic stimulation (TMS), all of which have been recognized for their safety and efficacy. Yet with popular solutions such as SSRIs achieving a modest remission rate, and many patients with OCD considered treatment-resistant, experts are turning to less conventional options, discovering how the interplay between psychedelics and OCD may yield greater relief for patients.

There are multiple potential mechanisms by which treatment with psilocybin may help alleviate the symptoms of OCD. Psilocybin interacts with different serotonin receptors in the brain, including those which seem to regulate certain brain regions of individuals with OCD. Treatment with multiple doses of psilocybin may change the binding activity of serotonin receptors such that symptoms are reduced. Psilocybin may also alleviate concerns with doubt and rumination, key elements underlying obsessions.

When it comes to OCD, a key advantage that psychedelic treatment offers is letting go. On a theoretical level, since OCD seems to revolve around the inability to relinquish control over one’s mind in the face of adverse thought content, it makes sense to circumvent the mental structures placed in one’s mind, via defense mechanisms and automatic thinking, with a drug that reaches deep within one’s unconscious.

Studies have cited that psilocybin can cause immediate improvement in OCD severity, as opposed to the weeks that usually take for SSRI medication to take effect. The psychedelic has particularly been shown to alleviate OCD symptoms of doubt and rumination.

That said, psychedelic mental health research—and particularly psychedelic OCD research—is still in its infancy, and much more needs to be verified before it can be considered a broad alternative to current, first-line OCD treatments, such as SSRIs and CBT. All psychedelic drug treatment options should be carried out in a safe environment and administered by a licensed mental health professional with experience in this form of therapy.

Psilocybin Therapy for Depression

The earliest studies in the US about psychedelics and depression occurred at Harvard University in the 1960s. Researchers investigated using psilocybin as an adjunct to psychotherapy. While the studies were promising, they ended in 1970 when psilocybin was classified as a Schedule I controlled substance, making all research illegal.

As the scientific understanding of the brain's neurochemistry grew and technology allowed for greater insight into brain anatomy, researchers began advocating for the ability to investigate psilocybin as a depression treatment. Studies in the early 2000s gauged tolerability and long-term effects in healthy individuals.

In the 2010s, researchers began assessing psilocybin's effects on people with depression. Separate researchers conducted double-blind randomized controlled trials that studied psilocybin's impact on depression symptoms in patients with cancer. They found significant and persistent depression relief in participants.

A 2016 open-label trial of psilocybin assessed 12 patients with moderate-to-severe depression that resisted treatment. Combined psilocybin treatment and psychological support led to significant symptom improvement.

Based on the strength of the developing body of research, the FDA designated psilocybin as a breakthrough therapy. This meant that the treatment was deemed a substantial improvement over available therapies and allowed doctors to conduct further investigations.

Promisingly, a 2020 trial of patients with depression found long-term relief, with the positive effects of two doses of psilocybin lasting for one year. Scientists are lobbying the government to reclassify psychedelics to allow further study.

Psilocybin and Dementia

The growing medical understanding of the neurological degeneration associated with dementia coincided with the reemergence of psychedelics as a potential treatment option for psychological and neurological conditions.

Scientists hypothesize that psilocybin's ability to elevate brain connectivity and communication may make it an effective treatment for managing dementia. While studies are promising, research into psychedelics and dementia is just beginning.

Preliminary studies revealed that psilocybin therapy may slow or halt the brain atrophy that contributes to the cognitive loss associated with dementia. While dementia is irreversible, the neuroprotective effects of psychedelics may extend function and quality of life.

Currently, investigators are assessing psilocybin's ability to manage depression, aggression, and anxiety that affect dementia patients. The treatment may improve patients' well-being and compliance with their healthcare. The treatment may reduce the incidence of violent outbursts in individuals with dementia.

Psilocybin is such a promising treatment that Johns Hopkins University is conducting a clinical trial on its effects on depressive symptoms in patients with depression and Alzheimer's Disease. This is one of the first studies focusing on psilocybin in cognitively impaired individuals.

The results will inform the current understanding of psilocybin's treatment value, enhance the understanding of psychedelics' effects on patients with dementia, and propel further investigations.

Psilocybin for Epilepsy

Research into psilocybin as an epilepsy treatment is limited and developing slowly. The delayed progress is partly due to the availability of effective conventional treatments.

However, patients still experience persistent epilepsy that resists treatment, justifying study into alternatives. The FDA recently approved an anti-epileptic drug containing CBD. Research into the treatment value of medical marijuana is ongoing.

In addition, some societal resistance to managing epilepsy with psychedelics exists over the lingering belief that they induce seizures. Researchers question the link between psychedelic use and epileptic episodes and propose they may be caused by another contributing factor when they do occur.

Anecdotal reports of seizures resulting from psilocybin use are difficult to examine due to pre-existing comorbidities, potential drug interactions, dosage, and the purity of the consumed psilocybin.

Investigations into psilocybin's treatment value for managing epilepsy will first look at current studies of healthy participants. Brain imaging and studies measuring brain activity will inform how researchers explore potential impacts on epileptic patients.

Scientists are currently exploring psilocybin's potential neuroprotective, anti-inflammatory, and neuroconnective properties. The findings will inform how the treatment could impact patients with epilepsy.

Clinical trials involving patients with epilepsy are likely far off. However, doctors will continue to research and form hypotheses because epilepsy is a lifelong condition and standard interventions are not effective for everyone.

Psilocybin to Treat Addiction

Psilocybin has never been “prescribed” for a mental health condition, per se. However, in the 1950s and 1960s, a number of research studies suggested that psilocybin (and similar compounds) was safe and may have broad potential therapeutic benefits for those with a number of mental health conditions, including depression and addiction.

More recent research with psilocybin has shown similar broad therapeutic potential, but it is obvious that any clinical application requires well-designed, extensive clinical research trials. Psilocybin, the active ingredient in psychedelic mushrooms, has shown promise in limited early studies, not only in treating addiction to alcohol and harder drugs, but also nicotine.

The FDA has also granted “breakthrough therapy” designation for psilocybin in both treatment-resistant depression as well as major depressive disorder. The breakthrough therapy designation is for drugs that treat serious or life-threatening conditions and for those for which preliminary clinical evidence indicates an ability to achieve clinically significant outcomes over available therapies.

Ongoing and future clinical trials will further evaluate psilocybin’s therapeutic potential in treating these and other addictions.